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1.
Gene Ther ; 22(1): 65-75, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25231172

RESUMO

In our earlier studies, Semliki Forest virus vector VA7 completely eliminated type I interferon (IFN-I)-unresponsive human U87-luc glioma xenografts, whereas interferon-responsive mouse gliomas proved refractory. Here, we describe in two clones of CT26 murine colon carcinoma, opposed patterns of IFN-I responsiveness and sensitivity to VA7. Both CT26WT and CT26LacZ clones secreted biologically active interferon in vitro upon virus infection but only CT26WT cells were protected. Focal infection of CT26WT cultures was self-limiting but could be rescued using IFN-I pathway inhibitor Ruxolitinib or antibody against IFNß. Whole transcriptome sequencing (RNA-Seq) and protein expression analysis revealed that CT26WT cells constitutively expressed 56 different genes associated with pattern recognition and IFN-I signaling pathways, spanning two reported anti-RNA virus gene signatures and 22 genes with reported anti-alphaviral activity. Whereas CT26WT tumors were strictly virus-resistant in vivo, infection of CT26LacZ tumors resulted in complete tumor eradication in both immunocompetent and severe combined immune deficient mice. In double-flank transplantation experiments, CT26WT tumors grew despite successful eradication of CT26LacZ tumors from the contralateral flank. Tumor growth progressed uninhibited also when CT26LacZ inoculums contained only a small fraction of CT26WT cells, demonstrating dominance of IFN responsiveness when heterogeneous tumors are targeted with interferon-sensitive oncolytic viruses.


Assuntos
Neoplasias do Colo/terapia , Terapia Viral Oncolítica , Vírus Oncolíticos/genética , Vírus da Floresta de Semliki/genética , Animais , Antineoplásicos/farmacologia , Antineoplásicos/uso terapêutico , Efeito Espectador , Linhagem Celular Tumoral , Neoplasias do Colo/imunologia , Neoplasias do Colo/patologia , Vetores Genéticos , Proteínas de Fluorescência Verde/biossíntese , Interferon Tipo I/farmacologia , Interferon Tipo I/uso terapêutico , Interferon beta/metabolismo , Camundongos Endogâmicos BALB C , Necrose , Transplante de Neoplasias , Fator de Transcrição STAT1/metabolismo , Transfecção , Resultado do Tratamento
2.
J Fr Ophtalmol ; 45(1): 28-33, 2022 Jan.
Artigo em Francês | MEDLINE | ID: mdl-34922778

RESUMO

OBJECTIVE: To determine the main causes of visual impairment according to age in patients admitted to the ophthalmology department. MATERIALS AND METHODS: This was a retrospective study of 501 cases of visual impairment. Included were patients of both sexes whose best-corrected visual acuity in the better eye was strictly less than 5/10. The parameters studied were age, gender, place of residence, corrected visual acuity in the better eye, and diagnosis. The data were entered and processed with the Epi info 7.2 software. RESULTS: Subjects over 50 were the most prevalent (48.5%). In patients over 50 years of age, cataracts (54.32%) were the leading cause of visual impairment, followed by glaucoma (24.69%) and non-glaucomatous optic neuropathy (26.19%). Trauma (17.62%) was frequently found in patients aged 16 to 50 years. Tropical endemic limbo-conjunctivitis (25.00%) was the leading cause of visual impairment in subjects aged 5 to 15 years. CONCLUSION: This study confirms the results of the literature, which have shown that cataracts are the leading cause of visual impairment in developing countries. A major effort to raise awareness, provide information and therapeutic care would reduce the incidence of visual impairment.


Assuntos
Catarata , Glaucoma , Baixa Visão , Centros Médicos Acadêmicos , Cegueira , Feminino , Humanos , Masculino , Prevalência , Estudos Retrospectivos , Baixa Visão/diagnóstico , Baixa Visão/epidemiologia , Baixa Visão/etiologia
3.
J Virol Methods ; 302: 114487, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35104497

RESUMO

The use of oncolytic viruses (OV) to precisely target and eliminate tumors ('virotherapy') is a rapidly evolving therapeutic approach to treating cancer. A major obstacle in virotherapy, especially for systemic administration, is the host's immune response towards the OV. In the case of measles virus (MeV), most individuals have been immunized against this agent leading to pre-existing neutralizing antibodies that can impair OV delivery to the tumor. These antibodies predominantly target the hemagglutinin (H) and fusion (F) envelope glycoproteins displayed at the particle's surface. Here, we introduce a novel and versatile pseudotyping platform for rapid envelope exchange of oncolytic MeV that allows for engineering of chimeric viruses invulnerable to pre-existing anti-MeV antibodies. Using this system, we have successfully exchanged the MeV F and H proteins with the glycoprotein G of vesicular stomatitis virus (VSV) and the surface proteins of Newcastle disease virus (NDV) or canine distemper virus (CDV), all of which are not endemic in the general human population. While the MeV-VSV and MeV-NDV pseudotypes were non-functional, the MeV-CDV pseudotype was successfully propagated to high-titer virus stocks. This study describes the successful generation of a robust envelope exchange platform for oncolytic MeV while also highlighting its intricate pseudotyping tolerance.


Assuntos
Terapia Viral Oncolítica , Vírus Oncolíticos , Animais , Anticorpos Neutralizantes , Vírus do Sarampo/genética , Vírus Oncolíticos/genética , Vírus da Estomatite Vesicular Indiana
4.
J Fr Ophtalmol ; 44(3): 409-414, 2021 Mar.
Artigo em Francês | MEDLINE | ID: mdl-33494971

RESUMO

INTRODUCTION: Glaucoma is the leading cause of irreversible blindness in the world. The purpose of our study was to evaluate the tonometric results of SLT treatment in patients with glaucoma. MATERIALS AND METHODS: This was a prospective study of patients with glaucoma who were seen from October 1, 2017 to July 31, 2018. All patients underwent SLT of the inferior 180°. Intraocular pressure (IOP) was measured before and then at 1, 15, 30, 60, 90 and 120days after treatment. RESULTS: We studied 35 eyes of 31 patients. The mean age was 59.3 (±8.4years), range 43-77years. The mean IOP prior to SLT was 20.1mmHg (±7mmHg). One day after the laser, this decreased to 17.6mmHg (±8.4), for a percentage of drop of 12.4%. At 30days, it was 15.3mmHg (±5.4mmHg), i.e. a 23.9% decrease. After 60 and 90days, there was a drop of 13.9% and 15.4%, respectively. At 120days, 43.3% of treated eyes had a decrease of at least 20%. The main complication was increased IOP in 14.2% of cases. CONCLUSION: SLT reduces IOP and the number of glaucoma medications in patients. It appears to be a viable alternative in our countries. These results should be confirmed with a larger cohort and longer follow-up.


Assuntos
Glaucoma de Ângulo Aberto , Glaucoma , Terapia a Laser , Trabeculectomia , Adulto , Idoso , Burkina Faso/epidemiologia , Glaucoma/epidemiologia , Glaucoma/cirurgia , Glaucoma de Ângulo Aberto/epidemiologia , Glaucoma de Ângulo Aberto/cirurgia , Humanos , Pressão Intraocular , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
5.
J Fr Ophtalmol ; 43(9): 907-912, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-32828564

RESUMO

INTRODUCTION: Childhood blindness is a public health problem in developing countries. The goal of this study was to focus on the epidemiological and clinical patterns of moderate to severe, uni- or bilateral childhood blindness and severe visual impairment in the ophthalmology department of Yalgado Ouedraogo university hospital (YOUH) in Ouagadougou, Burkina Faso. MATERIALS AND METHODS: We conducted a descriptive, cross-sectional analytic study based on retrospective data in the ophthalmology department of YOUH from January 1, 2010 to December 31, 2014. It included cases of childhood blindness and severe visual impairment (World Health Organisation: WHO) in children 0-15 years of age. The studied variables were sociodemographic and clinical data, visual outcomes, and avoidable aspects of their blindness (WHO). RESULTS: The prevalence of uni- or bilateral childhood blindness and severe visual impairment was 4.36% (398 cases out of 9125 children). The male/female ratio was 1.70. The mean age was 9±4 years old; 54% of children were school-age boys and girls; the most frequent causes among the 398 patients were traumatic (46.98%), infectious (12.31%) or congenital (10.05%). Most of the ocular injuries occured in boys (P<0.05) and school children (P<0.05). The injured structures resulting in childhood visual impairment were primarily the lens (30.65%) and the globe (27.64%). Childhood blindness and severe visual impairment were considered avoidable in 80.65% of cases. The type of visual disability was related to age, especially school age (P<0.0001) and to avoidability (P<0.05). CONCLUSION: Given the high prevalence of childhood blindness and severe visual impairment, early, effective management and preventive strategies should be employed.


Assuntos
Baixa Visão , Adolescente , Cegueira/epidemiologia , Cegueira/etiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Estudos Retrospectivos , Transtornos da Visão/epidemiologia , Transtornos da Visão/etiologia , Baixa Visão/epidemiologia , Baixa Visão/etiologia
6.
J Fr Ophtalmol ; 42(4): 361-367, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-30910329

RESUMO

INTRODUCTION: Ocular damage is one of the numerous complications of diabetes. Proliferative diabetic retinopathy can result in blindness. The purpose of our work was to study the aspects of diabetic retinopathy on fundus examination in diabetic patients in Bobo-Dioulasso in a hospital environment. METHODS: This is a descriptive, cross-sectional, prospective study from March 1st to August 31st 2014 of diabetic patients in the Sourô Sanou university hospital. We used the Francophone Diabetes Society's classification. RESULTS: We included 246 patients (487 eyes). The frequency of diabetic retinopathy (DR) was 47.1%, and the frequency of diabetic maculopathy 8.9%. Proliferative DR and severe Non-Proliferative DR represented 3.3% of eyes, and blindness occurred in 3%. Among diabetics with DR, the mean age was 55.75 years (standard deviation 11.04 years); the median duration of diabetes was 36 months, and 99.1% of the diabetic patients were categorized as type 2. There was a statistically significant association between diabetic retinopathy and duration of diabetes progression, history of neuropathy, presence of proteinuria on 24hour urines, hypercreatininemia, and also between triglyceride levels and diabetic maculopathy. CONCLUSION: Diabetic retinopathy affects almost half of diabetic patients at the Sourô Sanou university hospital. An earlier, multidisciplinary management approach might prevent this.


Assuntos
Retinopatia Diabética/diagnóstico , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cegueira/epidemiologia , Cegueira/etiologia , Burkina Faso/epidemiologia , Estudos Transversais , Retinopatia Diabética/complicações , Feminino , Fundo de Olho , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
Br J Cancer ; 99(10): 1613-22, 2008 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-18941459

RESUMO

Effective treatments for androgen-independent prostate cancer (AIPCa) are lacking. To address this, emerging therapeutics such as proteasome inhibitors are currently undergoing clinical trials. Inositol hexakisphosphate (IP6) is an orally non-toxic phytochemical that exhibits antitumour activity against several types of cancer including PCa. We have previously shown that treatment of PC3 cells with IP6 induces the transcription of a subset of nuclear factor-kappaB (NF-kappaB)-responsive and pro-apoptotic BCL-2 family genes. In this study, we report that although NF-kappaB subunits p50/p65 translocate to the nucleus of PC3 cells in response to IP6, inhibition of NF-kappaB-mediated transcription using non-degradable inhibitor of kappaB (IkappaB)-alpha does not modulate IP6 sensitivity. Treatment with IP6 also leads to increased protein levels of PUMA, BIK/NBK and NOXA between 4 and 8 h of treatment and decreased levels of MCL-1 and BCL-2 after 24 h. Although blocking transcription using actinomycin D does not modulate PC3 cell sensitivity to IP6, inhibition of protein translation using cycloheximide has a significant protective effect. In contrast, blocking proteasome-mediated protein degradation using MG-132 significantly enhances the ability of IP6 to reduce cellular metabolic activity in both PC3 and DU145 AIPCa cell lines. This effect of combined treatment on mitochondrial depolarisation is particularly striking and is also reproduced by another proteasome inhibitor (ALLN). The enhanced effect of combined MG132/IP6 treatment is almost completely inhibited by cycloheximide and correlates with changes in BCL-2 family protein levels. Altogether these results suggest a role for BCL-2 family proteins in mediating the combined effect of IP6 and proteasome inhibitors and warrant further pre-clinical studies for the treatment of AIPCa.


Assuntos
Anticarcinógenos/farmacologia , Apoptose/efeitos dos fármacos , Ácido Fítico/farmacologia , Neoplasias da Próstata/tratamento farmacológico , Inibidores de Proteases/farmacologia , Androgênios/metabolismo , Linhagem Celular Tumoral , Humanos , Masculino , Neoplasias da Próstata/metabolismo
8.
Health Policy Plan ; 33(2): 237-246, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29253138

RESUMO

Electronic health information systems, including electronic medical records (EMRs), have the potential to improve access to information and quality of care, among other things. Success factors and challenges for novel EMR implementations in low-resource settings have increasingly been studied, although less is known about maturing systems and sustainability. One systematic review identified seven categories of implementation success factors: ethical, financial, functionality, organizational, political, technical and training. This case study applies this framework to iSanté, Haiti's national EMR in use in more than 100 sites and housing records for more than 750 000 patients. The author group, consisting of representatives of different agencies within the Haitian Ministry of Health (MSPP), funding partner the Centers for Disease Control and Prevention (CDC) Haiti, and implementing partner the International Training and Education Center for Health (I-TECH), identify successes and lessons learned according to the seven identified categories, and propose an additional cross-cutting category, sustainability. Factors important for long-term implementation success of complex information systems are balancing investments in hardware and software infrastructure upkeep, user capacity and data quality control; designing and building a system within the context of the greater eHealth ecosystem with a plan for interoperability and data exchange; establishing system governance and strong leadership to support local system ownership and planning for system financing to ensure sustainability. Lessons learned from 10 years of implementation of the iSanté EMR system are relevant to sustainability of a full range of increasingly interrelated information systems (e.g. for laboratory, supply chain, pharmacy and human resources) in the health sector in low-resource settings.


Assuntos
Registros Eletrônicos de Saúde/organização & administração , Sistemas de Informação em Saúde/organização & administração , Implementação de Plano de Saúde , Recursos em Saúde , Confiabilidade dos Dados , Haiti , Humanos , Áreas de Pobreza
9.
Med Sante Trop ; 27(3): 315-318, 2017 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-28947410

RESUMO

To describe the epidemiology of uveitis in northern Bénin. This retrospective study carried out from records describing 10 years of uveitis care in 2 eye clinics in northern Bénin. The sample of 623 eyes with uveitis in 489 patients accounted for 1.0% of all consultations. A male predominance was observed with a sex-ratio of 1.5 (297 m/192 F). The patients' mean age was 35.7 ± 16.1 years, and the age range most often affected was 20-39 years. The uveitis was anterior in 32.3 %, posterior in 29.0 %, intermediate in 28.1% and total (panuveitis) in 10.6%. The cause was undetermined in 85.7 % of cases and identified in 14.3%, including toxoplasmosis in 47 cases (7.5%) and herpes zoster in 20 cases (3.2%). Outpatients accounted for all cases, and all received topical corticosteroids. Some complications were observed. Uveitis has a prevalence rate of 1% in northern Bénin. It caused blindness in 9.8% of affected eyes and impaired vision in 49.3%.


Assuntos
Uveíte/epidemiologia , Adulto , Idoso , Benin/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Adulto Jovem
10.
AIDS ; 9(12): F19-26, 1995 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-8605047

RESUMO

OBJECTIVE: A case of HIV infection clearance in a perinatally infected infant has been recently reported. We report here on the molecular, biological and clinical features of such virus clearance in 12 children. DESIGN AND METHODS: We performed a retrospective analysis of the diagnosis in our 6-year cohort of 188 children born to HIV-seropositive mothers. HIV-1 was detected by coculture of infant peripheral blood mononuclear cells (PBMC) with cord blood cells, direct culture of infant cells, and DNA polymerase chain reaction (PCR). The children were diagnosed three times during the first 3 months of life and then followed up over a postnatal period of 18-36 months. RESULTS: The 12 reverted children had at least two positive PCR in at least two amplified regions. Among them, six were tested positive in culture/coculture assay, and five were treated long-term with zidovudine. Thus, seven out of 12 reversions cannot be attributed to antiretroviral therapy. All the virological results became negative during the first year of life, and serology lowered to negative values between 9 and 23 months. We could not find any correlation between either neutralizing or antibody-dependent cellular cytotoxicity-mediating antibodies and HIV clearance. CONCLUSION: In our cohort, we showed that an unexpected number of children born to HIV-seropositive mothers (6.7%) cleared HIV infection during the first year of life, and subsequently became seronegative. Interestingly, most of these children exhibited unspecified clinical signs during the first months of life. Five of these children were tested positive only by PCR, which suggests a low virus load and could, at least partly, explain spontaneous clearance. However, 4 years later, among the seven remaining infants, two seronegative children presented recurrent hepatosplenomegaly, which may indicate the presence of hidden virus not detectable by peripheral blood testing.


Assuntos
Infecções por HIV/virologia , Relação CD4-CD8 , Técnicas de Cocultura , Estudos de Coortes , Ensaio de Imunoadsorção Enzimática , Anticorpos Anti-HIV/sangue , Infecções por HIV/epidemiologia , Infecções por HIV/imunologia , Infecções por HIV/transmissão , Humanos , Lactente , Transmissão Vertical de Doenças Infecciosas , Testes de Neutralização , Reação em Cadeia da Polimerase , Remissão Espontânea , Estudos Retrospectivos , Cultura de Vírus
11.
Trans R Soc Trop Med Hyg ; 80(6): 927-34, 1986.
Artigo em Inglês | MEDLINE | ID: mdl-3299905

RESUMO

Ivermectin (MK-933) has been compared with diethylcarbamazine (DEC) and placebo in a double-blind study in 30 adult male Senegalese patients with Onchocerca volvulus infection. 10 patients were randomly assigned to each treatment group. Ivermectin was administered as a single oral dose of 12 mg and DEC as 50 mg daily for two days and 100 mg twice daily for the following six days, total 1.3 g in eight days. Skin O. volvulus microfilaria densities remained near pre-study values in the placebo patients, but decreased rapidly with both active drugs to mean values about 2% of pretreatment (Day 8) and then increased slowly, reaching in 12 months about 4% of pre-treatment (ivermectin) and 18% (DEC). This difference is statistically significant. Clinical adverse reactions were recorded in four ivermectin, ten DEC and three placebo patients. One ivermectin and six DEC patients received steroid treatment for relief of these reactions. Serious adverse ocular changes were not seen in any patients, possibly because of the steroid therapy in the DEC patients. Adult O. volvulus from onchocercal nodules one and six months after treatment showed no effect of either drug on viability. Intra-uterine developing forms of the microfilariae appeared normal in all three treatment groups at the one month examination but deformed and degenerated forms were evident at six months in the ivermectin group but not in the DEC and placebo patients. Ivermectin as a single oral dose appears to be a safer and more effective microfilaricidal drug in human onchocerciasis than DEC in the standard multi-dose regimen.


Assuntos
Dietilcarbamazina/uso terapêutico , Ivermectina/uso terapêutico , Oncocercose/tratamento farmacológico , Adolescente , Adulto , Ensaios Clínicos como Assunto , Dietilcarbamazina/efeitos adversos , Método Duplo-Cego , Oftalmopatias/etiologia , Oftalmopatias/parasitologia , Humanos , Ivermectina/efeitos adversos , Masculino , Microfilárias/isolamento & purificação , Pessoa de Meia-Idade , Oncocercose/complicações , Prurido/induzido quimicamente , Pele/parasitologia
12.
Dakar Med ; 46(1): 79-81, 2001.
Artigo em Francês | MEDLINE | ID: mdl-15773167

RESUMO

Rubella is an innocuous illness in adult unless it is contracted by a pregnant woman. We recently observed a case of congenital rubella in the department of neonatology of Abass Ndao hospital in Dakar. It's a female new-born, born after 40 week gestation, with a well followed pregnancy. The first clinical examination shows a severe intrauterine growth retardation and bilateral comeal opacity. Maternal and new-born serologic confirmation is obtained with positive rubella specific IgM and IgG. We also find severe ocular pathology, hearing deficit and associated cardiac disease. This case shows the needs for preventive strategies, such as vaccination against rubella for women of child bearing age.


Assuntos
Síndrome da Rubéola Congênita , Feminino , Humanos , Recém-Nascido , Síndrome da Rubéola Congênita/diagnóstico
13.
J Fr Ophtalmol ; 35(6): 432-6, 2012 Jun.
Artigo em Francês | MEDLINE | ID: mdl-22498505

RESUMO

AIM: The purpose of this study is to screen the neonatal conjunctivitis in order to evaluate its incidence and especially to seek for the causative germs. PATIENTS AND METHODS: We have realized cross-sectional study in three health centers of the prefecture of Kozah from March 24 to May 12, 2009. All the newborns followed in these centers are examined in the search of signs of conjunctivitis. A biological diagnosis of conjunctival secretions was carried out at the suspect newborns. RESULTS: During the study period, 348 newborns were examined including 185 boys and 163 girls corresponding to a sex-ratio (M/F) of 1.1. The middle age was 3.7 days. Twenty-eight newborns presented conjunctivitis, that is to say a rate of incidence of 8%. The cases of conjunctivitis were observed the first four days of life in 39.3% of cases. Eighteen of the newborns presenting conjunctivitis were vaginal deliveries (64.3%) against ten (35.7%) by caesarian. All the mothers of the ill newborns had a syndrome of sexually transmissible infection (STI) during the third quarters of pregnancy. After biological diagnosis, Staphylococcus aureus was found in 25% of the cases. CONCLUSION: Despite the common herd of neonatal conjunctivitis prophylaxis by Crede's method, its remains in the prefecture of Kozah. In hope for neonatal conjunctivitis eradication, treatment of STI on pregnant women associated to education and communication on the prevention of the infection in neonatal health care centers and at home by hygiene rule application are necessary.


Assuntos
Oftalmia Neonatal/epidemiologia , Idade de Início , Feminino , Hospitais de Condado/estatística & dados numéricos , Humanos , Incidência , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Masculino , Oftalmia Neonatal/diagnóstico , Oftalmia Neonatal/microbiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Infecções Estafilocócicas/congênito , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/transmissão , Staphylococcus aureus/isolamento & purificação , Togo/epidemiologia
14.
J Fr Ophtalmol ; 34(8): 539-42, 2011 Oct.
Artigo em Francês | MEDLINE | ID: mdl-21803446

RESUMO

The authors report the first case of Eales disease described in Burkina Faso. A 21-year-old man presented myodesopsia with acute visual acuity decrease in the right eye at 1/50, vitreous haemorrhage, and retinal phlebitis of the large trunks. In the left eye, visual acuity was 10/10 P2, with phlebitis associated with retinal haemorrhages, vascular occlusion, and retinal ischaemia. Laboratory investigations found a positive TST at 20mm but the Koch bacillus was not isolated. The patient received treatment for tuberculosis, corticosteroids, retinal argon laser photocoagulation, and vitrectomy in the right eye. The clinical, immunopathological, and therapeutic aspects of Eales disease are discussed.


Assuntos
Neovascularização Patológica/diagnóstico , Vasculite Retiniana/diagnóstico , Burkina Faso , Humanos , Masculino , Neovascularização Patológica/complicações , Vasculite Retiniana/complicações , Tuberculose/complicações , Tuberculose/diagnóstico , Acuidade Visual , Adulto Jovem
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